Male Menopause: Fact or Fiction?

September 24th, 2010 § 13 comments

I hear that Mel Gibson allegedly blamed what he called depressed and “whacky” behavior on “male menopause.” Putting aside the question of whether he actually wrote the note circulating on the internet, (and that’s a big if,) is there a male menopause?  If the answer is yes, can it affect behavior and cause depression?

Testosterone levels do decrease, especially as a man gets older.  In one study, testosterone fell on average 110 ng/dL each decade in men over sixty.  As the FDA puts the normal line for testosterone in men at 300 ng/dL, that’s a big drop.  But it’s happening over ten years.

That’s the essential problem with calling the decline in testosterone as men age “menopause.” The word refers to the rapid plummet of women’s reproductive hormones around age fifty.  When a woman’s hormones drop in a short timespan, it’s fairly obvious to her that they’re changing .  But male hormones fall more gradually, though the decline is substantial.

Worse, a blood protein called “sex hormone binding globulin,” SHBG for short, is on the rise in the older man.  As its name implies, SHBG binds testosterone and renders it useless.  The drop in testosterone as men age is magnified by the climb in SHBG.

If testosterone was unnecessary, its decline would go unnoticed, but it’s one of the most important hormones a man has.  Low testosterone in older men is associated with muscle wasting, thinning of bones, loss of sex drive, depression and other problems.  Testosterone isn’t the only reason for these ailments, but it can be a big part of the puzzle.

If Mel did blame depression on “male menopause,” meaning a low testosterone, it’s possible that the 54 year old actor is feeling a drop in his hormones.  If he hasn’t already, he’ll want to get his testosterone checked.

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§ 13 Responses to Male Menopause: Fact or Fiction?"

  • Big Rob says:

    The male menopause definitely exists, whether you can use that as an excuse for being a nutter is another matter.

    Here in the UK when you hit 50 its fairly easy to get a testosterone boost from your Doctor to help with the problems.

  • Anonymous says:

    First, nice blog. Very informative.
    A couple of general questions.

    1. Does this stuff: diindolylmethane, have real documented effect? It’s advertised to lower estrogen, promote prostate health and do a bunch of things. It shows up in a fair amount of articles on Medline.

    2. Are family practice doctors equipped to handle low T (in general)


  • maledoc says:

    Thanks, John. The question of whether diindolylmethane works as advertised is complicated by the lack (to my knowledge) of controlled clinical trials. Few nutraceuticals have them, unfortunately. There is variability among family practice doctors in experience with men with low testosterone. Most doctors will tell you up front what they are comfortable treating, and what patients they would refer to another physician.

  • anonymous says:

    Thanks for the info. Here’s a couple of other things that I was wondering about.
    1. Vitamin D: You can do a Google search for “Vitamin D + Low T” and it appears that there plenty of sites that claim a correlation. Actually you can probably do a search for “dirty socks + low T” and get plenty of hits, but is there any real evidence for the vitamin D?

    2. The normal range on total T is wide. The development of bone structure, hair, musculature, and other traits is affected by T and presumably tissue sensitivity. How much influence do these 2 components have on a relative basis? Does a guy that looks like Teenwolf necessarily have upper end values of T?


    • maledoc says:

      Great questions! The relationship between vitamin D and testosterone is still being explored, and the jury’s still out on whether there is one. It makes biological sense that there would be one, but the data isn’t strongly supportive.

      The normal range for total testosterone is wide, so consider the lower limit a threshold. Bioavailable testosterone is likely a more meaningful assessment. Your question about the level of testosterone and function of cells such as hair cells is a great one. Many factors including the testosterone receptor and the cellular machinery driven by testosterone go into how the cells function, so there isn’t a simple relationship between the level of testosterone and the level of function of the cell. An example is “androgen insensitivity syndrome” where the testosterone receptor isn’t working quite right. Testosterone levels are very high, but function of testosterone sensitive cells is muted.

  • anonymous says:

    Thanks for the response. My labs include albumin as part of the general work-up for a physical as well as Total T and Free T. Nothing about Bioavailable T, but in in looking at the on-line calculator it seems like you can “back into” the SHBG and Bioavailable T numbers based on Total T, Free T, and albumin. Is this correct? If it is, wouldn’t it make sense for the lab to spend the extra 15 seconds to report the Bioavailable T?
    Thanks Again

  • maledoc says:

    Sorry, I can’t answer specific questions about your own health. See the FAQ at 🙂

  • anonymous says:

    OK. Intersting algebra/chemistry problem though. I’ll bet you don’t see that one every day.
    Thanks again for a cool site.

  • anonymous says:

    The endocrine sytem is fascinating so I’ll throw out another question. Response No. 5 states that testosterone sensitivity and intercellular biochemistry determine the effects of testosterone. Insulin is a also hormone and from what I can gather there are insulin receptors in all human cells. In Type 2 diabetes and insulin resistance, the cells seems to ignore the effects of insulin leading to inefficient transport of glucose. Weight loss and exercise seem to make insulin more effective by some means. Are there similar mechanisms or medications that make T more effective. I’m guessing the answer is “no”, otherwise professional athletes would be all over it.

  • maledoc says:

    The endocrine system *is* fascinating. Nature reuses many of the mechanics behind hormones, prompting scientists to investigate how insulin works may be related to how testosterone works. The jury’s still out. Recent studies have focused on how obesity may be a link between testosterone and diabetes. A recent review can be found at

  • David Morris says:

    The lower threshold of “normal” T is not universally established. And “normal” varies with a man’s age. Could you list the various “authorities'” standards? I think this is important, because Urologists (especially older ones) are often overly conservative in prescribing TRT, and patients need some info in order to reason with an overly cautious Urologist.

    • maledoc says:

      That’s a great point, David. Most of us use the FDA threshold of 300 ng/dL as a lower limit. As for “normal” varies with a man’s age: it depends on how you define normal. Most wouldn’t say that we should accept a higher fasting glucose with age and allow more diabetics to go untreated. The old notion of age-indexed testosterone should really be put to rest.

  • maledoc says:

    It’s been many years, and I’ve finally turned off comments for this WordPress blog. Why? Although it’s the first question in the FAQ, I still get comments (a bunch a day!) asking personal medical questions that I can’t answer. That’s sad and frustrating for me, because as a doctor, I really like to help patients. But this WordPress site was never meant to deliver personal medical care, and the University lawyers tell me that doing so would run afoul of State and Federal laws.

    If you have specific questions about your own personal care, I urge you as outlined in the FAQ to use the American Urological Association’s Society for the Study of Male Reproduction’s search engine

    I also urge you to read through all of and especially the comments. For the five or so years that it was active, A lot of excellent questions were asked, including by other healthcare providers. Chances are, if you have a general question, it’s been answered here and more than once.